INTERVENTIONAL BRONCHOLOGY IN PALLIATION OF CENTRAL BRONCHIAL-CARCINOMA

Despite all efforts the 5-year survival rate of bronchial carcinomas remains below 10%. Palliation for improvement of life quality is a daily challenge in a chest hospital. Besides radiation and chemotherapy., interventional bronchological measures gain importance as palliative measures. Forceps removal and endoscopical kryosurgery of tumor tissue have been replaced by ND-YAG lasertherapy. While thermal laser ablation is restricted to intraluminal tumors, brachytherapy (afterloading) is able to destroy tumor cells in and around the bronchial wall. Photodynamic therapy (PDT) with hematoporphyrins and dye-lasers is indicated for early cancer and flat and spreading tumors. Whether PDT is superior to thermal laser treatment of exophytic neoplasms remains to be answered. From its theoretical concept this is the most promising form of therapy because complete tumor eradication might be possible. Extrabronchial compression of the airways by tumor or lymph nodes can be prevented by stent implantation. Advantages and disadvantages of a variety of silicone and expandable stents are discussed. Based on our experience with 2000 palliative treatments, we present a flow chart with our decision structure and the techniques with examples.